653—9.4 (147,148,150,150A) Licensure examinations.
	 9.4(1) Requirements. To be eligible for permanent licensure, an applicant shall meet one of the following requirements:
	  a.   	 An applicant who has never been licensed in any United States jurisdiction shall pass the USMLE, COMLEX, or Medical Council of Canada Examination as prescribed in this rule and authorize the testing authority to verify scores.
	  b.   	 An M.D. applicant who has been licensed in any United States jurisdiction shall meet the licensure examination requirements in effect in Iowa at the time of original licensure if the examination precedes USMLE. An M.D. applicant who has been licensed in any United States jurisdiction based on USMLE shall meet the requirements in subrule 9.4(2). The applicant shall authorize the appropriate testing authority to verify scores obtained on the examination as specified in this rule.
	  c.   	 A D.O. applicant who has been licensed in any United States jurisdiction shall meet the licensure examination requirements in effect in Iowa at the time of original licensure if the examination precedes USMLE or COMLEX, whichever is applicable. A D.O. applicant who has been licensed in any United States jurisdiction based on USMLE or COMLEX shall meet the requirements in subrule 9.4(2) or paragraph 9.4(6)“a,” respectively.
	 9.4(2) USMLE.
	  a.   	 The USMLE is a joint program of FSMB and the NBME. The USMLE is a multipart examination consisting of Step 1, Step 2, and Step 3. Steps 1 and 2 are administered by NBME and ECFMG. The board contracts with FSMB for the administration of Step 3. USMLE Steps 1 and 2 were implemented in 1992; Step 3 was implemented in 1994.
	  b.   	 Since 1999, Step 3 is a computerized examination offered at testing centers in the Des Moines area and other Iowa locations.
	  c.   	 Applications are available at Department of Examination Services, FSMB, 400 Fuller Wiser Road, Suite 300, Euless, Texas 76039 or www.fsmb.org.
	  d.   	 Candidates who meet the following requirements are eligible to take USMLE Step 3:
	 (1) 	 Submit a completed application form and pay the required examination fee as specified in 653—subrule 8.3(1).
	 (2) 	 Document successful completion of USMLE Steps 1 and 2 in accordance with the requirements of NBME. Graduates of a foreign medical school shall meet the requirements of ECFMG.
	 (3) 	 Document holding a medical degree from a board-approved educational institution. If a candidate holds a medical degree from an educational institution not approved by the board at the time the applicant graduated and was awarded the degree, the candidate shall meet the requirements specified in 9.3(1)“c”(3).
	 (4) 	 Document successful completion of a minimum of seven calendar months of resident training in a program approved by the board at the time of the application for Step 3 or enrollment in a resident training program approved by the board at the time of the application for Step 3.
	  e.   	 The following conditions shall apply to applicants for licensure in Iowa who utilize USMLE as the licensure examination.
	 (1) 	 Passing Steps 1, 2, and 3 is required within a ten-year period beginning with the date of passing either Step 1 or Step 2, whichever occurred first. Board certification by the ABMS or AOA is required if the applicant was not able to pass Steps 1, 2, and 3 within the required time as specified in this paragraph.
	 (2) 	 Step 3 may be taken and passed only after Steps 1 and 2 are passed.
	 (3) 	 A score of 75 or better on each step shall constitute a passing score on that step.
	 (4) 	 Each USMLE step must be passed individually and individual step scores shall not be averaged to compute an overall score.
	 (5) 	 A failure of any USMLE step, regardless of the jurisdiction for which it was taken, shall be considered a failure of that step for the purposes of Iowa licensure.
	 (6) 	 Successful completion of a progressive three-year resident training program is required if the applicant passes the examination after more than six attempts on Step 1 or six attempts on Step 2 or three attempts on Step 3.
	  f.   	 Any candidate deemed eligible to sit for USMLE Step 3 is required to adhere to the examination procedures and protocol established by FSMB and NBME in the following publications: USMLE Test Administration Standards and Policies and Procedures Regarding Indeterminate Scores and Irregular Behavior, FSMB, 400 Fuller Wiser Road, Suite 300, Euless, Texas 76039.
	 9.4(3) NBME.
	  a.   	 NBME Part Examinations (Parts I, II, and III) were first administered in 1916. The last regular administration of Part I occurred in 1991, Part II in April 1992, and Part III in May 1994.
	  b.   	 Successful completion of NBME Parts I, II, and III was a requirement for NBME certification.
	  c.   	 A score of 75 or better on each part shall constitute a passing score on that part.
	 9.4(4) FLEX.
	  a.   	 From 1968 to 1985, (Old) FLEX was a three-day examination. Day 1 covered basic science; Day 2 covered clinical science; and Day 3 covered clinical competency. Applicants who took Old FLEX shall provide evidence of successful achievement of at least two of the following:
	 (1) 	 Certification under seal that the applicant passed FLEX with a FLEX-weighted average of 75 percent or better, as determined by the state medical licensing authority, in no more than two sittings.
	 (2) 	 Verification under seal of medical licensure in the state that administered the examination.
	 (3) 	 Evidence of current certification by an American specialty board approved or recognized by the Council of Medical Education of AMA, ABMS, or AOA.
	  b.   	 From 1985 to 1994, (New) FLEX replaced the Old FLEX. New FLEX was a three-day nationally standardized examination consisting of two, one and one-half day components referred to as Component I (basic and clinical science principles and mechanisms underlying disease and modes of therapy) and Component II (knowledge and cognitive abilities required of a physician assuming independent responsibility for the general delivery of medical care to patients). The last regular administration of both components of New FLEX occurred in 1993. Two special administrations of New FLEX Component I were offered in 1994 to examinees who passed Component II but not Component I prior to 1994. To be eligible for permanent licensure, the candidate must have passed both components in Iowa with a FLEX score of 75 or better within a seven-year period beginning with the date of initial examination.
	 (1) 	 Candidates who took the FLEX for the first time were required to take both components during the initial sitting. A candidate who failed either or both components must have repeated and passed the component failed, though Component II could only be repeated if the candidate had received a passing score of 75 percent or better on Component I.
	 (2) 	 Eligible candidates were permitted to sit for the initial examination and reapply to the board to repeat a failed component or complete the entire examination two additional times. However, candidates who failed either or both components three times were required to wait one year, during which time the candidate was encouraged to obtain additional training, before being permitted to sit two additional times for either or both components of the FLEX.
	 9.4(5) Combination examination sequences. To accommodate individuals who had already passed some part of the NBME Parts or FLEX before implementation of the USMLE, the USMLE program recommended and the board approved the following licensing combinations of examinations for licensure only if completed prior to January 1, 2000. These combinations are now only acceptable from an applicant who already holds a license from any United States jurisdiction.
	  a.   	 FLEX Component I plus USMLE Step 3 with a passing score of 75 or better on each examination;
	  b.   	 NBME Part I or USMLE Step 1 plus NBME Part II or USMLE Step 2 plus FLEX Component II with a passing score of 75 or better on each examination; or
	  c.   	 NBME Part I or USMLE Step 1 plus NBME Part II or USMLE Step 2 plus NBME Part III or USMLE Step 3 with a passing score of 75 or better on each examination.
	 9.4(6) Examinations for graduates of board-approved colleges of osteopathic medicine and surgery.
	  a.   	 COMLEX.
	 (1) 	 COMLEX is a three-level examination that replaced the three-part NBOME examination. COMLEX Level 3 was first administered in February 1995; Level 2 was first administered in March 1997; and Level 1 was first administered in June 1998. All three examinations must be successfully completed in sequential order within ten years of the successful completion of COMLEX Level 1. Board certification by the ABMS or AOA is required if the applicant was not able to pass Steps 1, 2, and 3 within the required time as specified in this paragraph.
	 (2) 	 A standard score of 400 on Level 1 or Level 2 is required to pass the examination. A standard score of 350 on Level 3 is required to pass the examination.
	 (3) 	 A candidate shall have successfully completed a minimum of seven calendar months of resident training in a program approved by the board at the time of the application for Level 3 or enrollment in a resident training program approved by the board at the time of the application for Level 3.
	 (4) 	 Successful completion of a progressive three-year resident training program is required if the applicant passes the examination after more than six attempts on Level 1 or six attempts on Level 2 or three attempts on Level 3.
	 (5) 	 Each COMLEX level must be passed individually, and individual level scores shall not be averaged to compute an overall score.
	 (6) 	 Level 3 may be taken and passed only after Levels 1 and 2 are passed.
	 (7) 	 A failure of any COMLEX level, regardless of the jurisdiction for which it was taken, shall be considered a failure of that level for the purposes of Iowa licensure.
	  b.   	 NBOME. The board accepts a passing score on the NBOME licensure examination for graduates of colleges of osteopathic medicine and surgery in any United States jurisdiction.
	 (1) 	 NBOME was a three-part examination. All three parts must have been successfully completed in sequential order within seven years of the successful completion of NBOME Part 1.
	 (2) 	 A passing score is required on each part of the examination.
	 (3) 	 A candidate shall have successfully completed a minimum of seven calendar months of resident training in a program approved by the board at the time of the application for NBOME Part 3. Candidates shall have completed their resident training by the last day of the month in which the examination was taken.
	 (4) 	 Successful completion of a three-year resident training program is required if the applicant passes the examination after more than six attempts on Part 1 or six attempts on Part 2 or three attempts on Part 3.
	 (5) 	 Each NBOME part must have been passed individually, and individual part scores shall not be averaged to compute an overall score.
	 (6) 	 Part 3 must have been taken and passed only after Parts 1 and 2 were passed.
	 (7) 	 A failure of any NBOME part, regardless of the jurisdiction for which it was taken, shall be considered a failure of that part for the purposes of Iowa licensure.
	 9.4(7) LMCC.
	  a.   	 The board accepts toward Iowa licensure a verification of a Licentiate’s registration with the Medical Council of Canada, based on passing the Medical Council of Canada Examination.
	  b.   	 The Medical Council of Canada may be contacted at P.O. Box/CP 8234, Station `T’, Ottawa, Ontario, Canada K1G 3H7 or (613)521-9417.